Arthroscopic Suprascapular Nerve Release

  • Timothy A. Hartshorn
  • Josef K. Eichinger
  • Lewis L. Shi
  • Jon J. P. WarnerEmail author


Suprascapular neuropathy is a disorder characterized by shoulder pain and/or weakness of the supraspinatus and infraspinatus muscles of the rotator cuff. Suprascapular neuropathy may present with a variety of clinical symptoms including pain and weakness in forward flexion, abduction, and external rotation of the shoulder, muscle wasting, as well as sensory disturbances about the superior and posterior aspects of the shoulder. Diagnosis is usually suspected in patients presenting with pain in the superior, posterior, or posterolateral aspect of the shoulder and isolated atrophy and/or weakness of the supraspinatus and/or the infraspinatus. This condition can also be present and not produce any symptoms, such as in volleyball players who may develop marked atrophy of the infraspinatus and external rotation weakness from traction on the suprascapular nerve without any pain, loss of function, or reduced efficiency when competing. Additionally, the frequent existence of concomitant shoulder disorders can make diagnosis of suprascapular neuropathy difficult.


Rotator Cuff Rotator Cuff Repair Suprascapular Nerve Supraspinatus Muscle Rotator Cuff Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 39.1

The video illustrates the arthroscopic procedure to perform suprascapular nerve release (WMV 19978 kb)


  1. 1.
    Witvrouw E, Cools A, Lysens R, Cambier D, Vanderstraeten G, Victor J, et al. Suprascapular neuropathy in volleyball players. Br J Sports Med. 2000;34:174–80.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Thomas A. La paralysie du muscle sous-pineux. Presse Med. 1936;64:1283–4.Google Scholar
  3. 3.
    Schilf E. Unilateral paralysis of the suprascapular nerve. Nervenarzt. 1952;23:306–7.PubMedGoogle Scholar
  4. 4.
    Clein LJ. Suprascapular entrapment neuropathy. J Neurosurg. 1975;43:337–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Antoniou J, Tae SK, Williams GR, Bird S, Ramsey ML, Iannotti JP. Suprascapular neuropathy. Variability in the diagnosis, treatment, and outcome. Clin Orthop Relat Res. 2001;386:131–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Zehetgruber H, Noske H, Lang T, Wurnig C. Suprascapular nerve entrapment. A meta-analysis. Int Orthop. 2002;26:339–43.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Gosk J, Rutowski R, Wiacek R, Reichert P. Experience with surgery for entrapment syndrome of the suprascapular nerve. Ortop Traumatol Rehabil. 2007;9:128–33.PubMedGoogle Scholar
  8. 8.
    Boykin RE, Friedman DJ, Zimmer ZR, Oaklander AL, Higgins LD, Warner JJ. Suprascapular neuropathy in a shoulder referral practice. J Shoulder Elbow Surg. 2011;20:983–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Lajtai G, Pfirrmann CW, Aitzetmuller G, Pirkl C, Gerber C, Jost B. The shoulders of professional beach volleyball players: high prevalence of infraspinatus muscle atrophy. Am J Sports Med. 2009;37:1375–83.PubMedCrossRefGoogle Scholar
  10. 10.
    Costouros JG, Porramatikul M, Lie DT, Warner JJP. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy. 2007;23:1152–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Vad VB, Southern D, Warren RF, Altchek DW, Dines D. Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy. J Shoulder Elbow Surg. 2003;12:333–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Mallon WJ, Wilson RJ, Basamania CJ. The association of suprascapular neuropathy with massive rotator cuff tears: a preliminary report. J Shoulder Elbow Surg. 2006;15:395–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Lee BC, Yegappan M, Thiagarajan P. Suprascapular nerve neuropathy secondary to spinoglenoid notch ganglion cyst: case reports and review of literature. Ann Acad Med Singapore. 2007;36:1032–5.PubMedGoogle Scholar
  14. 14.
    Semmler A, von Falkenhausen M, Schroder R. Suprascapular nerve entrapment by a spinoglenoid cyst. Neurology. 2008;70:890.PubMedCrossRefGoogle Scholar
  15. 15.
    Yi JW, Cho NS, Rhee YG. Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. J Shoulder Elbow Surg. 2009;13:e25–7.CrossRefGoogle Scholar
  16. 16.
    Solheim LF, Roaas A. Compression of the suprascapular nerve after fracture of the scapular notch. Acta Orthop Scand. 1978;49: 338–40.PubMedCrossRefGoogle Scholar
  17. 17.
    Travlos J, Goldberg I, Boome RS. Brachial plexus lesions associated with dislocated shoulders. J Bone Joint Surg Br. 1990;72: 68–71.PubMedGoogle Scholar
  18. 18.
    Visser CP, Coene LN, Brand R, Tavy DL. The incidence of nerve injury in anterior dislocation of the shoulder and its influence on functional recovery. J Bone Joint Surg. 1999;81B:679–85.CrossRefGoogle Scholar
  19. 19.
    Yoon TN, Grabois M, Guillen M. Suprascapular nerve injury following trauma to the shoulder. J Trauma. 1981;21:652–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Ferretti A, Cerullo G, Russo G. Suprascapular neuropathy in volleyball players. J Bone Joint Surg. 1987;69A:260–3.Google Scholar
  21. 21.
    Holzgraefe M, Kukowski B, Eggert S. Prevalence of latent and manifest suprascapular neuropathy in high-performance volleyball players. Br J Sports Med. 1994;28:177–9.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Ringel SP, Treihaft M, Carry M, Fisher R, Jacobs P. Suprascapular neuropathy in pitchers. Am J Sports Med. 1990;18:80–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Abboud JA, Silverberg D, Glaser DL, Ramsey ML, Williams GR. Arthroscopy effectively treats ganglion cysts of the shoulder. Clin Orthop Relat Res. 2006;444:129–33.PubMedCrossRefGoogle Scholar
  24. 24.
    Fehrman DA, Orwin JF, Jennings RM. Suprascapular nerve entrapment by ganglion cysts: a report of six cases with arthroscopic findings and review of the literature. Arthroscopy. 1995;11:727–34.PubMedCrossRefGoogle Scholar
  25. 25.
    Moore TP, Fritts HM, Quick DC, Buss DD. Suprascapular nerve entrapment caused by supraglenoid cyst compression. J Shoulder Elbow Surg. 1997;6:455–62.PubMedCrossRefGoogle Scholar
  26. 26.
    Tirman PF, Feller JF, Janzen DL, Peterfy CG, Bergman AG. Association of glenoid labral cysts with labral tears and glenohumeral instability: radiologic findings and clinical significance. Radiology. 1994;190:653–8.PubMedGoogle Scholar
  27. 27.
    Westerheide KJ, Dopirak RM, Karzel RP, Snyder SJ. Suprascapular nerve palsy secondary to spinoglenoid cysts: results of arthroscopic treatment. Arthroscopy. 2006;22:721–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Gaskin CM, Helms CA. Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients. Radiology. 2006;240:501–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Huang KC, Tu YK, Huang TJ, Hsu RW. Suprascapular neuropathy complicating a Neer type I distal clavicular fracture: a case report. J Orthop Trauma. 2005;19:343–5.PubMedGoogle Scholar
  30. 30.
    Visser CP, Coene LN, Brand R, Tavy DL. Nerve lesions in proximal humeral fractures. J Shoulder Elbow Surg. 2001;10:421–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Wijdicks CA, Armitage BM, Anavian J, Schroder LK, Cole PA. Vulnerable neurovasculature with a posterior approach to the scapula. Clin Orthop Relat Res. 2009;467:2011–7.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Rengachary SS, Burr D, Lucas S, Hassanein KM, Mohn MP, Matzke H. Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 2: anatomical study. Neurosurgery. 1979;5:447–51.PubMedCrossRefGoogle Scholar
  33. 33.
    Bayramo˘glu A, Demiry¨urek D, T¨uccar E, Erbil M, Aldur MM, Tetik O, et al. Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study. Knee Surg Sports Traumatol Arthrosc. 2003;11:393–8.CrossRefGoogle Scholar
  34. 34.
    Cummins CA, Anderson K, Bowen M, Nuber G, Roth SI. Anatomy and histological characteristics of the spinoglenoid ligament. J Bone Joint Surg. 1998;80A:1622–5.Google Scholar
  35. 35.
    Plancher KD, Luke TA, Peterson RK, Yacoubian SV. Posterior shoulder pain: a dynamic study of the spinoglenoid ligament and treatment with arthroscopic release of the scapular tunnel. Arthroscopy. 2007;23:991–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Demaio M, Drez Jr D, Mullins RC. The inferior transverse scapular ligament as a possible cause of entrapment neuropathy of the nerve to the infraspinatus. A brief note. J Bone Joint Surg. 1991;73A:1061–3.Google Scholar
  37. 37.
    Demirhan M, Imhoff AB, Debski RE, Patel PR, Fu FH, Woo SL. Suprascapular nerve entrapment under the spinoglenoid ligament: an anatomic and morphologic study. Orthop Trans. 1996;20:40.Google Scholar
  38. 38.
    Bigliani LU, Dalsey RM, McCann PD, April EW. An anatomical study of the suprascapular nerve. Arthroscopy. 1990;6:301–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Warner JP, Krushell RJ, Masquelet A, Gerber C. Anatomy and relationships of the suprascapular nerve: anatomical constraints to mobilization of the supraspinatus and infraspinatus muscles in the management of massive rotator-cuff tears. J Bone Joint Surg. 1992;74A:36–45.Google Scholar
  40. 40.
    Vorster W, Lange CP, Bri¨et RJ, Labuschagne BC, du Toit DF, Muller CJ. The sensory branch distribution of the suprascapular nerve: an anatomic study. J Shoulder Elbow Surg. 2008;17:500–2.PubMedCrossRefGoogle Scholar
  41. 41.
    Brown DE, James DC, Roy S. Pain relief by suprascapular nerve block in glenohumeral arthritis. Scand J Rheumatol. 1988;17:411–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality? Anesth Analg. 1997;84:1306–12.PubMedGoogle Scholar
  43. 43.
    Matsumoto D, Suenaga N, Oizumi N, Hisada Y, Minami A. A new nerve block procedure for the suprascapular nerve based on a cadaveric study. J Shoulder Elbow Surg. 2009;18:607–11.PubMedCrossRefGoogle Scholar
  44. 44.
    Albritton MJ, Graham RD, Richards 2nd RS, Basamania CJ. An anatomic study of the effects on the suprascapular nerve due to retraction of the supraspinatus muscle after a rotator cuff tear. J Shoulder Elbow Surg. 2003;12:497–500.PubMedCrossRefGoogle Scholar
  45. 45.
    Massimini DF, Singh A, Wells JH, Warner JJ. Suprascapular nerve anatomy during shoulder motion: a cadaveric proof of concept study with implications for neurogenic shoulder pain. J Shoulder Elbow Surg. 2013;22:463–70.PubMedCrossRefGoogle Scholar
  46. 46.
    Greiner A, Golser K, Wambacher M, Kralinger F, Sperner G. The course of the suprascapular nerve in the supraspinatus fossa and its vulnerability in muscle advancement. J Shoulder Elbow Surg. 2003;12:256–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Hoellrich RG, Gasser SI, Morrison DS, Kurzweil PR. Electromyographic evaluation after primary repair of massive rotator cuff tears. J Shoulder Elbow Surg. 2005;14:269–72.PubMedCrossRefGoogle Scholar
  48. 48.
    Youm T, Matthews PV, El Attrache NS. Treatment of patients with spinoglenoid cysts associated with superior labral tears without cyst aspiration, debridement, or excision. Arthroscopy. 2006;22:548–52.PubMedCrossRefGoogle Scholar
  49. 49.
    Maquieira GJ, Gerber C, Schneeberger AG. Suprascapular nerve palsy after the Latarjet procedure. J Shoulder Elbow Surg. 2007;16:e13–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Vachon T, Rosenthal M, Dewing CB, Solomon DJ, Shin AY, Provencher MT. Acute painless shoulder weakness during high-intensity athletic training. Am J Sports Med. 2009;37:175–80.PubMedCrossRefGoogle Scholar
  51. 51.
    Buschbacher RM, Weir SK, Bentley JG, Cottrell E. Normal motor nerve conduction studies using surface electrode recording from the supraspinatus, infraspinatus, deltoid, and biceps. PM R. 2009;1:101–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Casazza BA, Young JL, Press JP, Heinemann AW. Suprascapular nerve conduction: a comparative analysis in normal subjects. Electromyogr Clin Neurophysiol. 1998;38:153.PubMedGoogle Scholar
  53. 53.
    Gassel MM. A test of nerve conduction to muscles of the shoulder girdle as an aid in the diagnosis of proximal neurogenic and muscular disease. J Neurol Neurosurg Psychiatry. 1964;27:200–5.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Kraft GH. Axillary, musculocutaneous and suprascapular nerve latency studies. Arch Phys Med Rehabil. 1972;53:383–7.PubMedGoogle Scholar
  55. 55.
    Martin SD, Warren RF, Martin TL, Kennedy K, O’Brien SJ, Wickiewicz TL. Suprascapular neuropathy. Results of non-operative treatment. J Bone Joint Surg. 1997;79A:1159–65.Google Scholar
  56. 56.
    Romeo AA, Rotenberg DD, Bach Jr BR. Suprascapular neuropathy. J Am Acad Orthop Surg. 1999;7:358–67.PubMedGoogle Scholar
  57. 57.
    Black KP, Lombardo JA. Suprascapular nerve injuries with isolated paralysis of the infraspinatus. Am J Sports Med. 1990;18:225–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Walsworth MK, Mills 3rd JT, Michener LA. Diagnosing suprascapular neuropathy in patients with shoulder dysfunction: a report of 5 cases. Phys Ther. 2004;84:359–72.PubMedGoogle Scholar
  59. 59.
    Drez Jr D. Suprascapular neuropathy in the differential diagnosis of rotator cuff injuries. Am J Sports Med. 1976;4:43–5.PubMedCrossRefGoogle Scholar
  60. 60.
    Post M. Diagnosis and treatment of suprascapular nerve entrapment. Clin Orthop Relat Res. 1999;368:92–100.PubMedGoogle Scholar
  61. 61.
    Lafosse L, Piper K, Lanz U. Arthroscopic suprascapular nerve release: indications and technique. J Shoulder Elbow Surg. 2011;20:S9–13.PubMedCrossRefGoogle Scholar
  62. 62.
    Piatt BE, Hawkins RJ, Fritz RC, Ho CP, Wolf E, Schickendantz M. Clinical evaluation and treatment of spinoglenoid notch ganglion cysts. J Shoulder Elbow Surg. 2002;11:600–4.PubMedCrossRefGoogle Scholar
  63. 63.
    Lafosse L, Tomasi A, Corbett S, Baier G, Willems K, Gobezie R. Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: technique and preliminary results. Arthroscopy. 2007;23:34–42.PubMedCrossRefGoogle Scholar
  64. 64.
    Gartsman G. Shoulder arthroscopy. Philadelphia: Saunders/Elsevier; 2009.Google Scholar
  65. 65.
    Shah AA, Butler RB, Sung SY, Wells JH, Higgins LD, Warner JJ. Clinical outcomes of suprascapular nerve decompression. J Shoulder Elbow Surg. 2011;20:975–82.PubMedCrossRefGoogle Scholar
  66. 66.
    Chen AL, Ong BC, Rose DJ. Arthroscopic management of spinoglenoid cysts associated with SLAP lesions and suprascapular neuropathy. Arthroscopy. 2003;19:e15–21.PubMedCrossRefGoogle Scholar
  67. 67.
    Lichtenberg S, Magosch P, Habermeyer P. Compression of the suprascapular nerve by a ganglion cyst of the spinoglenoid notch: the arthroscopic solution. Knee Surg Sports Traumatol Arthrosc. 2004;12:72–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Boykin RE, et al. Current concepts review. Suprascapular neuropathy. J Bone Joint Surg Am. 2010;92:2348–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Timothy A. Hartshorn
    • 1
  • Josef K. Eichinger
    • 1
  • Lewis L. Shi
    • 2
  • Jon J. P. Warner
    • 3
    Email author
  1. 1.Harvard Shoulder ServiceMassachusetts General HospitalBostonUSA
  2. 2.Department of OrthopaedicsThe University of ChicagoChicagoUSA
  3. 3.M6H Shoulder ServiceMassachussetts General HospitalBostonUSA

Personalised recommendations